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00020090 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING A DURESS: P17RNII'I No, OWNEWS NAM[: AI'i'hICAIJ(Ipl„SU ?i 21121 STEVENS CREEK BLVD LI LnLI G0C10690Q PHONE; - SANITAHI ', .Nn. CITY OF CUPERTINO &/14/ n-V ARCIII'I'LCT/ENGINI ER: HOLDING PERM11 INFO fi I.OG ELECT PLUNIR MCCII CLL � ucls"scOcovrRACrOR'sOrcl,nllnnoN Job Description ZZ uJ G I heavily alum Ihm I i t licemed under,pnolemnx litChapter9 tuanmunnng pmI-w with Section 70(ID)of Divlend 3oLhe bu,itu,,mal Prof..hdx Cm1v. ndmyliceroe i,in full farce and effect. O i U Loser,Chex Lie.p Dam Common. LLa.< ARCHITEC s DECLARATION - - s�NJ Iaaderxlaadmvprn„halnacuw,da, mbl' m,r, BATHROOM FOR MEMORIAL P RK ,i p O l iccmm Vndc,xinnnl Dat I..t,I1.Dligr DECLARATION Com'rIx1N W=u 1 hereby a1Enn that 1 am emmpt tram the tc,,i W Co License Law for,he 1-Ea ibllowimquimoa rniiton]IIILtmctucine.,anJPc.deiintxc Cade:Aoy eityorounty iF.es which requires issuance,µmot to Dues the aper,improve,denmlix t or repair any ummer s. 'I he is hadpm,ntl ,,betholisiocam[he uall Conµnor,mtlnssignm,mtan<m ai— maths incing itpSectiouime pxnvl,iisin 3ofth Business Laccase Law(Chapter ode) Sq. FL FIOoI'Area ,111/alion (camp ensile with Section een and the 3 of the alleged and ion,provisions Cute) ' or that he is 31.5 b,therefrom ant the nulls for IM alleged exemption.Any violation in Section]0.115 by Day oll Fill a pannh amjmlx Ilm apPlicnm h+n civil penalty arum more than fee hundred area dmlarx($500). APN Number Occupancy$Type ❑I,as owner of the property.or my employee,with label ax Ilmi1 r.ol.cmnpenrution, will do,he work,and the%wane,is no,intended nr mFncd lar sale(Sec.71)th. Business and Professions Codc:The Contractor'%License Law Joel not apply to an Required Inspections orr of pn+peny Will,nodular improves Iharean,and who dhmx r,h work himxdr through his ow n employees.provided that such imprommems am not intended or offered far sac IL however.the building or..nprovemem is sold within one yam of inlap,echo,thenwmennaimerwillbasethen�medofprovhglhaIndid bawd, 101 — FOUNDATION hpmxe far purpose ar ease.,. ❑].;,,,,,act or the property,am emillively cormming with licensed eimrarl 1st 102 -— PIERS omm rl the project(Sec.7WJ,business and Provision%Cade:)The Contractor s Licedse Law does not apply Io an owner of property who nwlds or improve,thenen. 103 — UFER and who contracts Iia such moves with a counactor licensed jamicanl a+,he Conwram,License Law. 104 — REBAR ❑Iman esemp,amle,Sec. ,11&PCFir this na,00h 105 — ANCHOR BOLTS Dwnor WORKER'S COMPENSAr1ON DECLARATION 106 — SEWER & WATER Ihcrenr[firm anderpen:ttynfpe,imyone ofdin,ronowin,deemrmion,: 202 — UNDERFLOOR PLUMBIJIIG • ❑ I lettered wal nhainmin a Certmeme or Consent ,,self-in,me far Worker's 203 — UNDERFLOOR MECHANICAL Coma,topion, as prosided fir by Section 3700 or the Labor Code Iia the 204 — UNDERFLOOR FRAME ❑Il have and will It thrum Worker this permit is issued. Insurance, r wb Worker's n+mpen.alnooh mxurdna,a,reydirea by Section 205 — UNDERFLOOR INSULATION 3700 of the Labar node. in the wriomnmce or the work for wldeh aa,permit is 301 — ROUGH PLUMBING issued ply Worker'.x Compensation Insurance carrier and Policy number arc: OR SHOWER cam•. Policy NW: 302 TUB A' C17RTE'ICATION OF EXEM Pr1ON FROM WOR HERS' 303 — ROUGH MECHANICAL COMPIh.NSXIION INSURANCE - 304 ROUGH ELECTRICALELECTRICAL(This sean,Ih nom nm be eotnpmma it he perrna i,for one hundred dollars, = alOnmlesx.3 305 — FRAME 1 certify that is the perinndamic of IM1e work for which this permit i,issued,l 306 — HOLDOWNS shall no,employ any Dexw..I in uny mamter so ae,,heodti ea le” i Ihu WnrkarF Co307 — INSULATION mpencminn Laws of California.Data NOTICE g 1 308 — SHEETROCK Applicant AVPLICAMI':IL alter makin this Ccnilieatc of lixdm nlon.You should I+ecomc subject mthe Werker's Compenxapon proviswn,of the Labor Crate,you mast 309 — EXTERIOR LATH Q O fa,hwith comply with such prnvisiom or this Fermi,shall he domed revuka l FCONSTRUCTION LENDING AGENCY 310 — INTERIOR LATH I hereby alllrte Ihal thele ix a oma mesion lending ngodxy for me Pvoimnlater, aIthe work for which list,permit is issued(see.3097.Cit.C.) 31 1 — SCRATCH COAT R7 Q Lender's ;D z Lender..%Nvac+rare» 313 — ROOF NRIL U Q Icertify that ihave readthis application and nudm that the above Information 1% 501 — FINAL ELECTRICAL ENERGY LU F souset.lagreel,Icoolie, ill,all city and eotttyordknanee,andxtlelaws elatial 502 — FINAL PLUMBING ENERGY Q U mFederal,construction.andhembyentrain representatives 01this city toenter upon y Ihcnalle-dleotonedprop In,epeeli"aparlow, 503 — FINAL MECHANICAL ENERGY F„ p„ (We)agar mxuvc ladem"l'y and keep hauN „ esh<Ci ty of Caren ran ugaiuxl m liabilities,judgments.costs and expco,es which may,in any way assom again,said 504 — FINAL BUILDING ENERGY U Z, Clty In camcyucaceor the gmming of his permi t. r SOUHCANTUNREGUERST5NDSANDWILLCOMPLYWITHALLNON-POINT Issued by: 505 — FINAL ELECTRICALDate Sigwmre of Applicam/Cen ..I,,, Dmc Re-roofs HAZARDOUS MATERIALS DISCLOSURE507 — FINAL PLUMBING Wit me appdeam oe h....m addiog"ccI,aore onh:IltJle n:I.ardon,ma,ariw 'Type of Roof as defined hy'the Cupertino Municipal Code.Chapter 9.12,and the licahb and Safety 508 — FINAL' MECHANICAL_ Code.Section 255121071 ❑Yes ❑No All roofs shall Gdllfdapectlid]IP`5i4o yR�� ng material being installed. Wtumeapplicant orfuture building occupant use equknohentirdevices which If a roof is instglpoZwithcUtItidSBlobtfRhi 4M?ection. 1 agree to remove emi,wtu ons air canwnllnnnh,ax JdinuJ by the BuY Area Num Air Guulihy Managcn con,lrar all new materia Icy'iD4:p4etJlppA16pPLIJ$1LIIILf7eIW©RKSld will comply with oYes "^ all non-point source regulations. I have read the hmamuus materials acquirements under Chapter 6.95 of the Calreaiu I laahh N Safety Coale,Sections 25505.25513 and 25534 I undersand that if the building does not currently have a moron,that It is my lesponeirli,y to notify the occupant of the requirements which must Ihe met prior to issuance of a Certificate of Decal+aner Signature of Applicant Date ownmor mderimd agcal D,I" All roof coverings to be Class ••B" or better